Calories during labour to help prevent interventions

f62d4998f2044d8b6f801afb308d8966

Importance of calories during labour

By Y.Rademeyer
Integrative Dietitian & birth Doula

Historical facts:)

Hippocrates recommended that prolonged third stage of labour be treated with a mixture of dried placenta, stallion testicle and urine from the husband! (1).

Those are fun facts but that is not what we are suggesting 🙂

Since the 1940’s, eating and drinking during labour has been prohibited in hospitals due to the risk of stomach content aspirating into the lungs if at any point general anaesthesia is required[2]. This is called Mendelson syndrome and Mendelson made a few rules for labour.

This rule has been questioned for quite a while now, firstly because general anaesthesia is no longer the norm when cesarean surgeries are performed[3][4]. 

Secondly, on the contrary, when a woman is deprived of calories during labour, her body has to produce the energy from elsewhere and often at the expense of labour progression.

Women in ketosis during labour are at a higher risk of medical interventions such as labour augmentation, foreceps delivery, cesarean sections and post partum bleeding[5][6].

So there is an irony in wanting to withhold calories in case of cesarean and withholding calories actually increasing the risk of cesarean!

Therefore it has been proposed that women should be encouraged to eat and drink freely during labour[7].

When the body is not able to derive energy from glycogen (carbohydrates), it will access fat from the liver via ketones in a regulated and controlled fashion. This is a harmless physiological state called dietary ketosis [8.]

Ketones transport fat derived energy from the liver to the rest of the body as an alternative source of energy.

Under normal circumstances ketosis indicates a normal physiological response to episodes of increased energy requirements and indicates the needs for calories and fluids [9].

During labour, due to physical stress and decreased oral intake, ketosis is a common occurance [10][4].

Ketosis can lead to medical interventions in two ways:

  1. Ketosis in itself may not necessarily be a problem, but having a caloric deficiency or being dehyrated may definitely slow labour or even stop contractions. In a hospital setting, This will most likely lead to the intervention of labour augmentation in the form of pitocin(synthetic oxytocin). Labour augmentation is known to result in a more painful labour since contractions are very strong and the body is not going with its natural flow of hormones that aid every stage appropriately and act as natural pain relievers. This means the next step to be pain medication. Augmentation and pain meds can both increase a woman’s chance of needing forceps assistance, and episiotomy or cesarean.

Again, in normal circumstances ketosis may be well regulated and in itself is not the main concern as long as the body is able to adapt appropriotely and medical science is actually still unclear on whether ketosis during labour is a normal response (since women naturally have a depressed appetite, and ketones are in fact a great respiratory fuel; BREATHING! [8]) or if it is a cause for intervention[5]. But  if you are in a hospital setting, the options are IV fluids, oral intake or no intervention.

2. In the hospital setting, the chosen intervention is usually IV fluids[11] even though there is no concrete evidence that intervention is required[5]. Being hooked up to IV fluids due to ketosis could be the main catalyst leading to interventions. IV fluids could have adverse effects on mom and baby : 

Firstly by interfering with glucose and insulin levels(causing maternal hyperglycaemia/neonatal hypoglycemia and jaundice) [10][6][12][13] or lowering sodium levels.  Infants may have acidic blood and increased lactate levels. Other adverse effects reported with the intervention of IV fluids are headache, nausea, maternal fluid overload, slowing labour, difficulty establishing breastfeeding, pain and discomfort, lack of movement.[6][5]

Being connected to IV fluids restricts a labouring women’s movement. This affects labour in multiple ways but for one, movement and gravity is needed for hips to open and for baby to move down and secondly, movement is a powerful mental tool for a mother in labour to feel in control of her experience and be empowered. Without the autonomy of movement, many women fail to progress in labour and this also will lead to the intervention of labour augmentation or cesarean birth.

IV fluids also have the potential of fluid overload on mom and baby’s lungs and the need for baby to be observed in intensive care due to increased breathing rate at birth.

This concept is important for all labouring moms but especially important for first time moms who want an unmedicated vaginal delivery, since first time labours are usually much longer and may be accompanied by a long prelabour, requiring more calories and fluids than shorter labours.

How much calories to consume during labour?

One study identified 50-100 calories spent in an hour of labour[14].

Fluids are the most important during labour since dehydration is a cause for ketosis. Be sure to have carbohydrate rich foods during prelabour and the first stages of labour. The desire to eat during later stages of labour is not high and we want mom to be in the zone and not thinking of necessarily eating a whole meal. The body’s energy is also not primarily directed at digestion  during labour and therefore small, high calorie, easy to digest snacks are recommended in later stages of labour. Stay hydrated throughout !

To see more on snack ideas during labour stay tuned for the next post.

 

Reference:

[1] Broach J, Newton N. Food and beverages in labor. Part II: the effects of cessation of oral intake during labor. Birth 1988;15(2):88‐92.

[2] Scheepers HCJ, Thans MCJ, Jong PA, Essed GGM, Cessie S, Kanhai HHH. A double‐blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour. British Journal of Obstetrics and Gynaecology 2002;109:178‐81.

[3] Anderson T. Is ketosis in labour pathological. Practising Midwife 1998;1(9):22‐6.

[4] Goer H. Obstetric myths versus research realities: a guide to the medical literature. Westport: Bergin & Garvey, 1995.

[5] Toohill J, Soong B, Flenady V. Interventions for ketosis during labour. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004230. DOI: 10.1002/14651858.CD004230.pub2. Link to Cochrane Library.

[6] Foulkes J, Dumoulin JG. The effects of ketonuria in labour. British Journal of Clinical Practice 1985;39(2):59‐62.

[7]  Singata M, Tranmer JE. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2002, Issue 4. [Art. No.: CD003930. DOI: 10.1002/14651858.CD003930]

[8] Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood “Villains” of Human Metabolism
Anssi H Manninen. J Int Soc Sports Nutr. 2004; 1(2): 7–11.. Published online 2004 Dec 31.

[9] McKay S, Mahan C. Modifying the stomach contents of laboring women: why and how; success and risks. Birth 1988;15(4):213‐21.

[10] Dumoulin JG, Foulkes JEB. Ketonuria during labour [commentary]. British Journal of Obstetrics and Gynaecology 1984;91(2):97‐8.

[11] Sleutel M, Sherrod S. Fasting in labor: relic or requirement. J Obstet, Gynecol & Neonatal Nurs 1999; 28(5):507-12.

[12] Hazle NR. Hydration in labor‐‐is routine intravenous hydration necessary?. Journal of Nurse Midwifery 1986;31(4):171‐6.

[13] Johnson C, Keirse MJN, Chalmers I. Nutrition and hydration in labour. In: Enkin M, Keirse MJN, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J editor(s). A guide to effective care in pregnancy and childbirth. 2nd Edition. Oxford: Oxford University Press, 1989.

[14] Marchese T, Coughlin JH, Adams CJ. Nurse midwifery: health care for women and newborns. J Nurse Midwifery 1983; 18:115-75.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s